| NPI | 1003055534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: UT 6763842-1202) |
| Additional Taxonomies | 111NX0100X Chiropractor, Occupational Health (Licence: UT 6763842-1202) |
| Enumeration Date | 2009-02-06 |
| Last Update Date | 2012-11-06 |